Music Therapy
1995:Vol. 13, No. 1, 13-46
Cognitive and Affective Processes
in Music Therapy with Individuals
with Developmental Delays:
A Preliminary Model
for Contemporary
Nordoff-Robbins Practice
KENNETH AIGEN, DIRECTOR OF RESEARCH,
NORDOFF-ROBBINS CENTER FOR MUSIC THERAPY,
NEW YORK UNIVERSITY
Research on contemporary Nordoff-Robbins
clinical prac­
tice suggests that developmentally-disabled
children ex­
hibit a wide range of musical and expressive skills, from
the ability to beat a melodic rhythm on a drum to being
able to transform an habitual, pathological stance to the
outside world through musical interaction. This article
incorporates Serafine’s (1988) cognitive theory of music to
support the notion that these skills, rather than learned in
a rote manner, indicate instead the presence of highly
developed cognitive capacities. A four-tiered model is pre­
sented in which these various skills are organized accord­
ing to the particular psychological domain for which they
are most relevant.
The proposed model integrates work in what is tradi­
tionally considered developmental
therapy with areas of
intervention
that are more characteristic of music psycho­
therapy. In this preliminary research report, clinical exam­
ples are offered to illustrate
the underlying
processes
discussed in the model. Correlations to treatment will be
pursued in subsequent reports.
14
Aigen
Introduction
Juliette Alvin (1965) was one of the first authors to systematically
discuss the interaction of emotional, social, intellectual, and physi­
cal processes activated in disabled children by music therapy.
From the observation that such children experience uneven matu­
ration in these areas, she attributed the value of music therapy to
the ability of clinically-directed musical experiences to effect inte­
gration of experience in these different realms. However, Alvin
did not go into detail regarding specific processes, and her pio­
neering work did not make an explanatory connection between
cognitive processes and affective, self-expressive ones.
Alvin did, however, distinguish between musical sensibility
and musical aptitude, with the former referring to the capacity to
appreciate music as a listener and the latter to the potential to
acquire skill in creating or performing music. The model pre­
sented herein builds upon her recognition that sensibility (as
Alvin defined it) has physical, sensuous (and particularly) intel­
lectual, and emotional components. She also noted that lack of
aptitude can obscure a child’s sensitivity because without either
the verbal or musical means to express such sensitivity, i.e., per­
formance skills, the child’s sensitivity cannot be communicated to
others.
Edith Boxill (1985) argues that music therapy gains its efficacy
as a primary treatment modality for developmentally-disabled
individuals because music has direct effects upon all the domains
in which they experience dysfunctions, including the motoric,
communicative, cognitive, affective, and social. She further ob­
serves that music can bypass areas of cognitive deficit because its
“messages can be apprehended at autonomic levels [and they] do
not require encoding or decoding to be beneficial” (p. 18). Boxill,
however, presents these ideas as general principles and does not
link specific cognitive operations with musical expressions.
The most in-depth study in the area of music therapy with
developmentally-disabled children is that of Paul Nordoff and
Clive Robbins (1977). Their work represents an overall approach
to music therapy, encompassing theoretical psychological con­
structs, clinical techniques, exercises for training therapists, and
two rating scales for initial and ongoing evaluation: ScaleI. Child-
Cognitive
and Affective Processes in Music Therapy
Relationship in Musical Activity;
Communicativeness.
Therapists
15
and Scale II. Musical
The first scale consists of ten levels of participation that assess
a child’s capacity for interpersonal relating through music, and
the second consists of ten levels of communicativeness that pro­
vide a means for charting the development of a child’s ability to
use music as a communication tool.
Nordoff and Robbins (in press) created a third device, ScaleIII.
Musical Response].’ It provides separate hierarchic taxonomies for
rhythmic and melodic forms, differentiated by their complexity.
The scale for rhythmic forms was derived principally from work
with drums, and the melodic forms were evaluated primarily as
they emerged in therapy as products of vocalizations or singing.
The authors emphasize that “in neither can the clinical signifi­
cance of a response be determined by its structural form alone-the
degreeof activation or engagement expressed in it must be recog­
nized as having at least equal importance.” This engagement is
discerned through the various expressive components of music,
“such as the accelerando, fermata, diminuendo, [and] rubato.”
The authors state that psychological processes activated through
musical apprehension/expression include “awareness, percep­
tion, attention, ideation, concentration, memory
emotional
responsiveness, emotional differentiation, receptive-expressive
integration and self-expression.” However, they do not relate
these processes directly to individual acts-or classes--of musical
expression.
The present research relates to, and builds upon, these prior
efforts in three ways. First, by discussing and analyzing the active
and receptive musical abilities of disabled children in terms of the
cognitive processes implied by, or embedded in, their demon­
strated abilities, I hope to bring a higher degree of specificity to
the important-but
only generally stated-observation that crea­
tive music therapy accessesthe healthier and more intact aspects
‘This scale, which has previously existed solely as an unpublished manuscript,
will appear in the forthcoming revised edition of Creative Music Therapy (St.
Louis, MO: MMB).
16
Aigen
of these children. By linking these musical abilities to specific
cognitive operations, I believe it is possible to get a better picture
of musical intelligence and the overall functioning potential of
developmentally-disabled children. For example, due to the level
of detailed analysis afforded by high quality audio-video records
of music therapy sessions, and the advanced training of the clini­
cians who analyze these records, we have begun to find ways to
infer the presence of sensitivity, even though it may be expressed
through extremely limited performance skills.
Second, Nordoff and Robbins’ Musical Responsescale described
above was drawn from a clinically rich, although musically lim­
ited (in terms of the types of instruments available to the children),
variety of expressions. Because of the sheer amount of children
who have received (and continue to receive) treatment in the
intervening years, we have much more information regarding
rhythmic and melodic skills on pitched percussion instruments as
well. Further, experience has also demonstrated the complexity of
harmonic abilities in these children (such as the ability to sing or
play tones indicating the anticipation of cadences) in addition to
the melodic and rhythmic ones detailed above. Hence, we are now
in a position to correlate expressions of different musical elements
with one another and group them according to the functional
relationship to music that they demonstrate, as well as their
complexity.
Last, by placing emotional expression on a single continuum
with cognitive abilities, I hope to bring a greater level of integra­
tion to the profession of music therapy that will allow us to
understand developmentally-disabled
individuals in a more
complete and humane way. Other music therapy theorists in this
area (Orff, 1974; Alvin, 1965) have emphasized that music stimu­
lates integrative, cognitive capacities for those who typically have
had deficits in this area. However, there have been relatively few
examples of clinicians who have worked with, and theorized
about, affect in a psychotherapeutic way through music with this
client group. Yet a recently completed work (Aigen, in press) has
shown that traditional group therapy processes were exhibited in
a group of developmentally-disabled adolescents-including
af­
fective expressions. Because music therapists work directly with
these individuals’ affective expressions, one of the goals of this
Cognitive
and Affective Processes in Music Therapy
17
research is to codify and integrate the work that therapists are
already doing, while laying some groundwork for developing
connections between work on musical/cognitive skills and the
more traditional goals of psychotherapy, such as enhanced emo­
tional self-awareness and expressiveness.
Moreover, it should be kept in mind that this model emerged
from studying therapists implementing a particular approach to
music therapy and is thus a reflection of the skills of the children
involved as well as the Nordoff-Robbins approach. It is an impor­
tant finding in understanding Nordoff-Robbins music therapy
that we see work on the cognitive, aesthetic, and affective levels
proceeding concomitantly. This multi-level clinical approach it­
self reflects the degree to which practitioners in this tradition
believe in the importance of working with the whole person.
Notes on the Research Method
Sample and Design Rationale
The current research consisted of two sequential case studies.
The first was a preliminary study of a musically gifted, blind,
autistic child named Nicole. From this case study, a model was
developed that was then tentatively applied in a more limited
fashion to a second, similar autistic child-Joshua. The model was
subsequently found to be readily applicable to the second child’s
therapeutic process as well.
Too often, case studies have been criticized for their lack of
generalizability. However, Robert Stake (1978) argues that “in the
study of human affairs
case studies will often be the preferred
method of research because they may be epistemologically in
harmony with the reader’s experience and thus to that person a
natural basis for generalization” (p. 5). The knowledge afforded
by case study research leads to “naturalistic generalizations” that
are “arrived at by recognizing the similarities of objects and issues
in and out of context and by sensing the natural covariations of
happenings” (p. 6). Such generalizations may be arrived at intui­
tively, yet they still must meet empirical constraints.
18
Aigen
While case studies may not guarantee that the sample studied
is representative of a given population, this representativeness is
more important when one is seeking to generalize to a population.
Administrators charged with policy decisions affecting large
groups of individuals may require such a representative sample.
Yet, when the realm of application is other similar individu­
als-and for clinicians, the realm of application is the individual
rather than the “population’‘-the
rich description characteristic
of the case study is more important than is representativeness of
the sample in determining into which contexts, or for which
individuals, the original findings may be applicable.
In order to take advantage of the highly developed expertise of
the therapists participating in this research, the data-gathering
procedures were kept as nearly as possible homologous to the
practices in which these therapists typically engage while imple­
menting treatment. Part of their treatment includes a painstaking
review of video tapes of every session, focusing on (at times)
subtle, minute changes in aspects such as facial expressions, body
language, the tonality of nonverbal musical vocalizations, and
fleeting moments of musical contact and coherence. Given that
these therapists’ natural, tacit understandings develop through
the meticulous analysis of single individuals over periods of
years, the current research method conformed to this procedure
in order to formulate findings, i.e., to create a model, that would
be useful because it was constructed from procedures that mir­
rored those of the therapists’, thus meeting Stake’s criteria for
naturalistic generalization.
For the initial stages of this research, it was decided to employ
what Lincoln and Guba (1985) refer to as “purposive sampling.”
This is defined as “sampling extreme or deviant cases to obtain
information about unusual casesthat may be particularly trouble­
some or enlightening [emphasis in original]” (p. 200).
The children selected for this research are both visually-im­
paired, autistic, severely developmentally-disabled, yet musi­
cally-gifted. The rationale for choosing children with a high
degree of musicality was that such children are more likely to
display skills and sensitivities on a variety of levels and thus offer
a more complete picture of how music is used within music
therapy sessions. Because it was intended for this research to be
Cognitive
and Affective Processes in Music Therapy
19
stages of model development, the decision was made
to first apply it to those children most likely to provide a more
general picture of the entire range of functioning, rather than look
at one level in specificity, which might occur should a less pur­
posive sample be employed.
After studying the first child, Nicole, a second child, Joshua,
who is also musically sensitive but who is of a minority group and
a less advantaged socio-economic status, was selected for study.
By studying children from different cultural backgrounds, I
hoped to increase the probability that the resultant model would
be less culturally-specific. In future development of this model,
children whose musical sensitivity is more representative of the
developmentally-delayed population will be considered to adjust
it to broaden its realm of application.
These considerations follow Lincoln and Guba (1985) who
discuss the “serial selection of sample units” and “continuous
adjustment or ‘focusing’ of the sample” (pp. 201-2). In serial
selection, “each successive unity can be chosen to extend informa­
tion already obtained, to obtain other information that contrasts
with it, or to filI in gaps in the information obtained so far” (p.
201). Further, as the researcher gains expertise in the area of study
and begins to generate hypotheses, they suggest that subsequent
casesfor study be chosen based upon their potential in addressing
the researcher’s ongoing concerns.
the incipient
Research Method and Protocol
The primary method of data gathering, analysis and presenta­
tion is that of “Naturalistic Inquiry” as discussed by authors such
as Guba and Lincoln, 1981; Lincoln and Guba, 1985; Ely, Anzul,
Friedman, Garner, and Steinmetz, 1991; and, Erlandson, Harris,
Skipper, and Allen, 1993. This approach offers several advan­
tages: it employs constant movement among data gathering,
analysis, and write-up; it encourages the use of a variety of data
sources; it provides for descriptively rich accounts deemed suit­
able for this type of study; and, it encourages looking at individu­
als rather than impersonal processes.
The research protocol was selected because it was found to
allow for the flexibility characteristic of good qualitative methods
20
Aigen
while still providing for systematic inquiry. This protocol was first
applied to Nicole’s course of therapy and led to the development
of the model. Subsequently, the model-although
not the re­
search protocol-was applied to Joshua. It was found to capture
the salient elements of his process, although the musical realiza­
tions differed from those seen with Nicole. The research protocol
for Nicole was as follows:
1) A musically gifted child was identified who had
received at least one full year of music therapy ses­
sions. Her participation was contingent upon her
therapists’ and parents’ willingness to participate in
the study.
2) Video archives of Nicole’s previous three-year course
of therapy, maintained by the Nordoff-Robbins Cen­
ter for Music Therapy, were viewed by the investiga­
tor in their entirety.
3) As the sessions were viewed, an observation log was
maintained in which all significant musical interac­
tions and expressions were recorded.
4) Analytic memos were written after each group of
four to six sessions to discern categories in which the
musical expressions might be organized; to compare
these categories to the categories already identified
and adapt the model to accommodate the new find­
ings; to maintain a constant re-evaluation of the over­
all focus of the study and design; and to stay vigilant
about the investigator’s preconceptions and “blind
spots.”
5) The music therapists for Nicole were consulted dur­
ing the study and again at the final write-up to evalu­
ate the investigator’s interpretations. All of the
tentative conclusions regarding the children’s abili­
ties were checked with these therapists, and they had
the opportunity to evaluate the raw data, i.e., the
session tapes, and determine how well the investiga­
tor’s descriptions conformed to the information on
Cognitive
and Affective Processes in Music Therapy
21
the tapes, and if the conceptual analyses of the inves­
tigator were warranted by the abilities demonstrated
by the children.
After the model was developed with Nicole, Joshua was iden­
tified as the second participant in the research. The researcher
viewed a video tape compilation of Joshua’s therapy that had been
prepared for his mother’s viewing at an annual conference at
which Joshua’s lines of development and areas of difficulty were
detailed. Excerpts from this tape were selected by the researcher
and subject to the same scrutiny as Nicole’s, detailed in step (5)
above.
Description
Perceptual, Cognitive,
of the Model
and Affective
Considerations
The proposed model presupposes, and is consonant with, the
view of music (Meyer, 1956) that holds that the experience of
music is something that we actively construct through the inte­
gration of a variety of processes: sensory, perceptual, cognitive,
and affective. From this integrated stance, musical activity and
understanding is explained by the order and affective content
imbued onto the music by the individual, rather than through the
perception of these qualities as being inherent in the music itself.
Hence, when one displays competence as either a listener, per­
former, or composer of music (and in subsequent uses of the term
“competence,” all three of these activities are included), a whole
host of cognitive/affective processes necessary for musical com­
petence are implicated.
For example, a perceptual theory of music would attempt to
explain how we detect and identify the melody of a piece of music
through reference to the physics of sound waves and their impact
on our physiological mechanisms of hearing; the melody exists
“out there,” and as listeners we detect it through perceptual
means. Our musical competence may presuppose perceptual
processes, but these processes do not explain musical competence
any more than theories of visual perception explain competence
22
Aigen
at playing a game of chess, for example. Instead, just as chess
competence can be explained through appeals to internalized
rules and strategies, musical competence can be explained
through internalized cognitive operations and abstract repre­
sentations
A cognitive theory would hold that the perceptual processes
necessary for experiencing sound do not enlighten us as to how
sound is heard as music. Mary Louise Serafine (1988) has devel­
oped a cognitive theory of music based on empirical studies in
which she delineates the various cognitive processes underlying
the ability to create and experience music. What makes this system
so valuable is that it is generic rather than style-specific. For
example, she describes the process of closure as the ability to
understand that “music is divisible by temporary resting points”
(p. 40). A particular style principle that follows from this generic
process is that one rests at the tonic in a given phrase. But “resting
at the tonic” is the way that one culturally specific style-western
classical music-embodies this universal principle. It is the uni­
versal principle that is primary and explains our ability to learn
the conventions of a given musical tradition.
Table 1.
Serafine Model of Fundamental,
in Experiencing Music
Generic Processes
I. TEMPORAL
PROCESSES
A) Succession: “Chaining, grouping or horizontally adding events”
(Serafine, 1988. p. 74). A short unit isconceived, successive units are
added, two or more units are reconstituted into a new whole.
1.
Idiomatic Construction: Sound events that are logically
discrete and isolable are perceived or felt as a continuous
gesture . earlier tones are tied to later ones.
table is a summary of the conceptual system presented in Music As
Cognition:TheDevelopmentofThoughtin Soundby Mary Louise Serafine (New
This
York: Columbia
University
Press), 1988.
Cognitive
2.
3.
4.
and Affective
Processes in Music Therapy
23
Motivic Chaining: Two or more units/motives combined suc­
cessively into a longer one.
Patterning: When motives/units are chained repetitively,
patterns result.
Phrasing: Grouping musical events into clusters or phrases.
B) Simultaneity: “Combining and synthesizing musical events vertically”
(Serafine, 1988, p. 77).
1.
Tonal Synthesis: e.g., Combining notes to form a chord.
Timbre Synthesis: Combining multiple timbres into one.
2.
Motivic Synthesis: Blending two melodies so that they retain
3.
their unity or combine to form a new melody.
Textual Abstraction: Organizing simultaneous streams of
4.
activity into figure-ground relationships, e.g., discerning the
melody against a harmony.
II. NON-TEMPORAL
A) Closure: Understanding
sation, e.g., cadences.
PROCESSES
points of stasis and stability which imply ces­
B) Transformation: This process is the basis for similarity/difference
judg­
ments in music as these can be described by the steps that would be
entailed to transform one event into another.
Relative Repetition: Exact repetition of a musical event with
1.
figurative changes, such as playing a melody in
a different key or register.
Ornamentation: Alteration through addition.
2.
Substantive Transformation: In which a transformed musical
3.
event is related to its original only in an abstract way, such
as sharing a melodic contour.
C) Abstraction: Some aspect of a musical event is removed or considered
apart from its original context and a relationship/connection
is implied.
1.
2.
Motivic Abstraction: e.g., Fragment of Theme (A) is used in
Theme (B).
Property Abstraction: Rhythmic pattern, melodic contour,
etc., is used elsewhere.
D) Hierarchic Levels: Discerning tones which articulate a piece’s structure.
Imposing of a more simplified, reduced structure on the vast array of
sounds in a piece.
24
Aigen
Serafine (1988) considers music to be “the activity of thinking in
or with sound” (p. 69) and notes that “wherever a repeatable
composition is conceived, there will be reflection upon it as to its
salient and necessarily repeated features” (p. 37). In other words,
she is suggesting that to develop a relationship with a piece of
music, to learn it, to learn to identify with it, to detect and recall
those attributes that define it, all require a certain level of intellec­
tual reflection and abstraction. Because music is such a transient
phenomenon, it requires greater degrees of conscious reflection
in assimilating its principles than do other art forms. The contri­
bution of Serafine’s model is to highlight the fact that the various
musical skills and sensitivities imply underlying processes, some
of which are present on more than one level of the clinical taxon­
omy.
Why is this view of music of importance for music therapy in
general, and for this model in particular?
In the cognitive view of music, the presence of musical compe­
tence indicates abstract processes that may not be evidenced in any
other way. Similarly, in the Nordoff-Robbins approach, it is be­
lieved that music bypasses areas of pathology or dysfunction to
access an individual’s healthy core (Nordoff & Robbins, 1977;
Robbins & Robbins, 1991). Thus, to say that music accesses the
healthy is to say that cognitive and affective processes not other­
wise detected are activated in and through music. This supports
the theory that the presence of musical competence alone is suffi­
cient to postulate the existence of abstract and other cognitive
processes that are not activated or detectable through other
means, such as purely verbal ones.
Structure of the Model
The four levels of the model are listed in Table 2. For the time
being, the receptive or purely cognitive aspects of these levels
have not been distinguished from the active or performance as­
pects. The rationale is that musical skills are an example of what
Schon (1983) defines as “knowledge in action” and that, in some
cases, it may not be fruitful to distinguish “doing” from “know­
ing.”
Cognitive
and Affective
Processes in Music Therapy
25
Table 2.
Four Levels of Interaction With/In Music
LEVEL
LEVEL
LEVEL
LEVEL
4
3
2
1
Affective Musical Expression
Aesthetic Musical Awareness/Creation
Dynamic Musical Intelligence
Concrete/Basic Musical Skills
Some of the processes described by Serafine can be seen on all
four levels of the clinical model and others are limited to specific
levels. For example, the set in Group I-A, Successive-Temporal
Processes, could be seen on multiple clinical levels. Consider a
child who is playing the following sequence of notes at the piano:
“B-A-G, B-A-G, A-G-F, A-G-F”.3 We might want to infer that the
processes of idiomatic construction and motivic chaining are being
exhibited as the child is (a) integrating isolated tones into a se­
quence, and, (b) building a chain as two sequences are combined
to form a longer unit. This could be a paradigmatic example of
Level 1 skills. However, if the therapist initiated the “G” and “F”
chord pattern and the child responds with the tonal sequence, and
perhaps emphasized (rhythmically or dynamically) the repeti­
tions of the “G” and “F” notes, we might see this as an example
of Level 2 skills. The difference is that in the former example, the
notes are merely organized into units; in the latter, we can infer
the musical logic behind the organization which implies that the
child is aware of the tonal significance of the notes in the sequence.
Thus, any of the cognitive processes on the lower levels can be
displayed on the upper levels, if their musical manifestations
reflect the dynamic, aesthetic, or affective content characteristic of
that level. On the other hand, processes first appearing on a higher
level cannot be applied to lower levels. As an example, consider
a child playing two simultaneous notes on the piano. Unless they
are heard as a forming interval-unless their musical function is
apprehended-we
would not want to attribute the ability of tonal
This isnot a hypothetical
example but is taken from my current clinical practice.
26
Aigen
synthesis to the child. Merely playing two notes simultaneously
is not enough to make an attribution of Level 2 skills. Hence, tonal
synthesis is restricted to Levels 2 and above.
To understand the relation between Serafine’s theory and the
preliminary model presented here, think of the model as a four­
story building with the processes discussed by Serafine as the
bricks comprising the structure of each floor. Because this research
is in its beginning stages, all of the connections between the two
have not yet been made, but, wherever possible, their linkages are
shown in the following description of the model and in the
subsequent clinical musical illustrations. It should be noted that
the processes identified by Serafine, which are linked to a given
level, should be understood as emerging on that level and exhib­
ited on the subsequent levels aswell. Also, it should be recognized
that one limitation of Serafine’s view in application to music
therapy is that it does not address the role of affective processes
in music. Regardless, it is applicable to the first three levels of the
proposed model, although it is difficult to assess its utility for
Level 4 where affective content isprimary.
LEVEL 1: Concrete/BasicMusical Skills
The Level 1 processes involve the most primary operations in
how we understand and create music as music. They are the
cognitive building blocks for our ability to understand, live in, and
manipulate the other levels of musical activity. These primary,
organizing processes are logically embedded or embodied in the
other levels. This is not to suggest, however, that they are acquired
developmentally as precursors of abilities in the other areas, but
that they are activated as we function on these other levels.
Musically, this first level involves the ability to do things such
as (a) understand or recognize a succession of logically distin­
guishable tones as forming the unitary phenomenon of a melody;
(b) recognize isolated beats on a drum as forming a rhythmic
phrase; and (c) play or sing either an improvised or a pre-com­
posed melody. The cognitive processes implied here include those
that Serafine (1988) defines as idiomatic construction, motivic chain­
ing, patterning, phrasing, and timbre synthesis (see Table 1). These
are not to be considered rote skills, since even in the recognition of
isolated tones as constituting a melody there is the beginning of
Cognitive
and Affective Processes in Music Therapy
27
abstract thought, the concept that “the melody” is developed from
discreet, concrete tonal events.
Although, these Level 1 operations do not necessarily have
expressive or aesthetic value, they do reflect a cognizance of the
units of organization in music.
LEVEL 2: Dynamic Musical Intelligence
The concept of musical intelligence refers to our awareness of
the forces present in themelodic, harmonic, and rhythmic impetus
of music. Awareness on this level allows the listener/per­
former/composer to understand and utilize the various conven­
tions of different musical idioms and styles. This involves the
cognitive abilities Serafine (1988) identifies as tonal synthesis, tex­
tual abstraction, closure, relative repetition, and hierarchic levels (see
Table 1).
On a musical level, this intelligence includes the ability to
understand, use, or develop expectations regarding such things
as intervals, harmonies, and cadences. Being able to convey that
we understand the directions a given melody or rhythmic pattern
may take, as well as discerning the more relevant aspects of a
multi-faceted musical event, such as distinguishing a melody
from elements of the accompaniment, also belongs on this level.
In general, the processes at this Level allow us to be able to
organize the elements in Level 1 into greater degrees of abstrac­
tion and complexity.
These Level 2 operations may not necessarily have aesthetic or
expressive value, but they represent purely musical phenomena,
as opposed to the skills in Level 1, which reflect generalized
cognitive operations applied to music.
LEVEL 3: Aesthetic Musical Awareness/Creation
The Level 3 processes involve our considerations of valuation
or quality in the music. They are implicated when we as therapists
appreciate the character of musical expression, when a client’s
music has the more intangible elements of a “feel,” when a client
shows cognizance or appreciation of musical forms, or creates
music that complements the therapist’s Manifestations of aes­
thetic processes reflect inner qualities, not capable of being me­
chanically reproduced, and they thus necessarily involve a novel
28
Aigen
or creative contribution on the part of the client/musician. This
awareness can involve the cognitive processes Serafine (1988)
describes as motivic synthesis, ornamentation, substantive transfor­
mation, motivic abstraction, and property abstraction (see Table 1).
Musically, these processes are manifest in creating a well­
formed melody, playing music with an appropriate feel, entering
music at significant moments such as on pick-up beats on the first
beat of a measure, syncopating or otherwise varying melodies,
leaving musical spaces, and understanding cadences and vari­
ations in the context of ongoing music.
LEVEL 4: Affective Musical Expression
This fourth level is the ability to create or live in music that
contains felt emotions. It is the process that breathes life into music
that may be otherwise simply well-organized and pleasing. What
develops at this level is the ability to express oneself and relate to
others on an emotional level by infusing aspects of one’s affective
life into the music. No novel cognitive-musical process are postu­
lated as being specific to this level, although social and emotional
processes are present that are not manifest on the other levels.
It may not be immediately apparent that cognitive, musical
skills are required for this fourth level of personal expression and
interpersonal relating. One might argue that a client pounding
clusters of dissonant notes on a piano is expressing him/herself
without displaying any apparent skills. In this schema, however,
one can see that if the clusters are self-expressive because of the
dissonance, then the client isnecessarily (a) organizing thevarious
tones into clusters, (b) hearing the clusters as dissonance, and (c)
hearing the dissonance as a tension producing element which
manifests his or her inner state. These three skills are implied. If
the dissonance is not the self-expressive element, then the client
might just as well pound a cushion and not engage in musical self
expression. In other words, making the clinical judgment that the
music is self-expressive means that we are necessarily attributing
the presence of intervening, cognitive processes. If the pounding
on the piano is pure emotional discharge, then it would not be
self-expressive.
Cognitive
and Affective Processes in Music Therapy
29
The crucial point is that hearing dissonance, tension, resolution,
tonal direction, etc. is not a matter of perception but of cognition.
Hearing the aspects of music that make it aesthetic or expressive
necessarily involves internal, mediating processes.
Elaborations on the Model
To grasp all four levels at work, it might be helpful to think of
an individual’s experience and understanding of melody (see
Table 3). When a child demonstrates an understanding that a
melody exists as a unified phenomena, through either recognition
of or the ability to reproduce a melody, this would fall within
Level 1 (Concrete/Basic Musical Skills). Serafine’s (1988) cogni­
tive operation of idiomatic construction is implied because the child
is able to understand perceptually discrete events (represented by
isolated tones) as a created unity, i.e., “the melody.”
When a child demonstrates an understanding of why a given
melody is constructed as it is, by showing overtly or implicitly an
understanding of its tonal motion, this would indicate a Level 2
(Dynamic Musical Intelligence) process. To be classified at this
level, it is not enough for the child to reproduce a melody me­
chanically; instead, the child would need to sing, play, or other­
wise respond with an appropriate
dynamic or rhythmic
emphasis, thus showing an awareness of the naturally stressed
tones of given melody. Serafine’s (1988) cognitive operation of
closure is implicated as the child demonstrates an awareness of the
natural points of stasis in music.
A Level 3 (Aesthetic Musical Awareness/Creation) skill could
involve the creation of a well-formed melody, one that incorpo­
rates intervallic leaps, is comprised of a patterned contour, or rests
on significant tones. Cognitively, as novel melodies are created
from pre-existing ones, Serafine’s (1988) concepts of ornamentation
and substantive transformation are implied.
On Level 4 (Affective Musical Expression), children are able to
infuse or recognize aspects of their emotions/feelings in a mel­
ody. Music becomes most personally self-expressive in this way.
30
Aigen
Table 3.
Illustrations
of the Model in Terms of Melody
LEVEL 4
Infusing/recognizing aspects of one’s emotions
or feelings in a melody.
LEVEL 3
Creating or hearing the interesting
or novel aspect of a melody.
LEVEL 2
Hearing why a given melody is constructed as it is.
LEVEL 1
Understanding that a melody exists.
On Levels 1 and 2, the child is gaining knowledge of musical
rules and conventions, such as the idea that discreet tonal events
are grouped in certain ways and combinations (Level l), and that
certain tones are more likely to proceed to certain others (Level 2).
On Levels 3 and 4, the knowledge gained is more in the arena of
knowing how to utilize the raw materials being mastered in
Levels 1 and 2 in the service of creative self-expression. Thus, the
knowledge gained transcends the implementation of rules and
conventions.
Expansion
of the Model
Initially, the research model consisted solely of these four hier­
archical levels, with abilities in the higher levels being dependent
upon the presence of lower level abilities. However, in the pre­
liminary study with Nicole, and particularly in the application of
the model to the second child, Joshua, we repeatedly encountered
expressions on the lower levels that were more sophisticated than
those encountered in the higher levels. These counter-examples
suggested the development of a second dimension of the model,
the dimension of complexity. By adding this dimension, it was
possible to preserve themodel’s basic hierarchical structure, while
adapting to findings which at first seemed to challenge its utility.
The model with the added degrees of complexity, including mu­
sical illustrations of each, is presented in Table 4.
While all of the examples of musical expressions and responses
within Table 4 have been seen in the research, they function here
primarily as illustration, and not all of them are present in the
Musical Expressions and Responses
SKILL
LEVELS
increasing complexity
LEVEL 4
Affective
Enjoying/re­
sponding to mu­
sic that reflects
present affect.
Creating music
from one’s cur­
rent feeling state
Creating/allowing music to
transform an inner conflict
or problematic emotional
state
Creating or allowing music to
affect deep-seated or long­
standing growth inhibiting pat­
terns of thought or action
LEVEL 3
Aesthetic
Ornamenting a
melody
Playing with a
certain “feel” or
syncopation
Creating or responding to
melodies that reflect
awareness of-but are not
bound by-standard rules
of tonal motion
Reacting to, playing off of, or
otherwise showing cogni­
zance of unusual cadences
LEVEL 2
Dynamic
Discovering in­
tervals
Discovering
chords
Showing preferences for
the more stable tones of a
key while improvising
Anticipating cadential move­
ment
LEVEL 1
concrete
Repeating brief
rhythmic figures
Playing the ma­
lodic rhythm of a
known song on a
drum
Approximating the tonal
contour of a known mel­
ody, whether sung or
played
Rendering a melody accu­
rately
Development can be see either in increasing complexity (horizontal axis) or movement to other levels
(vertical axis) or in a greater consolidation of skills which would not appear as movement through the
elements of this model.
32
Aigen
clinical material in this study. Moreover, the examples chosen do
not reflect an equivalent degree of complexity across the various
levels. In other words, it is not claimed that the fourth example of
Level 1 reflects the same degree of complexity as the fourth
example on Level 4.
This model should be considered taxonomic rather than devel­
opmental. There is no claim that the course of therapy or the
development of musicality in children traces a movement through
either dimension of this model.4 What is presented here is a way
of organizing the various areas of clinical focus, with particular
emphasis on showing the interdependency of cognitive and affec­
tive processes. When working on concrete or cognitive goals, an
individual is also laying the foundation for work of a more expres­
sive or affective character; similarly, when working with affective
expression, one is by necessity engaging underlying cognitive
processes. I am coming to believe that the strict demarcation
between affective and cognitive processes in clinical work is more
of an abstraction that, while useful for some purposes, does not
truly reflect the way that human beings actually function.
Working with cognitive, motoric, behavioral, and affective lev­
els during one and the same course of therapy is characteristic of
the Nordoff-Robbins approach. This four-level model comprises
a structure for organizing these efforts according to the relation­
ship to music they suggest.
Clinical Examples5
Because of the preliminary nature of this research report, the
clinical excerpts on the audio tape accompanying this journal
4See Briggs (1991) for a developmental
therapy
model particularly
suited for music
5Both Nicole and Joshua have been seen in individual
music therapy for a
number of years. The clinical examples in this report were selected merely to
illustrate this model, and no effort was made to capture all, or even most, of the
salient factors in their courses of therapy. Only through detailed case studies
could the actual nature of their development in music therapy be captured. Such
a video study is currently under preparation by Nicole’s therapists, Carol and
Clive Robbins.
Cognitive
and Affective Processes in Music Therapy
33
were chosen because of their value in exemplifying the model. In
subsequent studies the model will be more fully developed and
its implications for treatment will be more fully elaborated.
Nicole’s Music
Simply put, Nicole embodies the word “survivor.” Weighing
only 600 grams when she was born at 24-weeks gestation, Nicole
has endured a number of life-threatening physical complications.
She lived on a respirator until she was 12 weeks old, and severe
digestive problems left her with only one-sixth of her small intes­
tine. Nicole has never ingested food or drink by mouth: All of her
nutrition is supplied by a gastrostomy tube and a catheter directly
into her heart ventricle. Most of her early years were spent in and
out of hospitals. She is autistic, severely intellectually impaired,
and visually impaired. When she began music therapy at 4½
years of age, she exhibited few verbal skills. Her therapy has
covered a wide range of musical, expressive, communicative, and
inter-personal goals. Her musical intelligence and aesthetic sensi­
tivity have helped her to make dramatic gains in all of these areas,
and her therapists have worked tirelessly to invoke these
strengths to help overcome her predilection for engaging in soli­
tary activities.
At the time this study was undertaken, Nicole had completed
three years of individual music therapy with Carol and Clive
Robbins, from November, 1990, through June, 1993. They see a
side of Nicole that supersedes her difficulties:
Despite her difficult and hazardous start in life-or
perhaps because of it-she shows a strong will to live
and to assert herself. Music is uniquely important in her
life, and in musical activities she can manifest the
strength of her personality actively and directly.
She
has “made music her own” and can live in it with
self-determined motivation; our task has been to live in
music with her in the attempt to make it a means of
self-discovery and self-realization for her. We have also
worked to make music into a field of interaction and
communication that might open to her the possibilities
of sharing more deeply in human relationships. (per­
sonal communication, August 1993)
34
Aigen
Audio Excerpt #I (SIDE Al: Session 1 (11/29/90)
Nicole enters the room for her first session, and Carol Robbins
provides her with a clear musical idea and tonality while helping
her to understand where she is by singing, “Here we are in music.”
As Nicole approaches the piano, aided by Clive Robbins, Carol
sees that she wants to play. Carol moves her right hand up an
octave and stops singing to allow Nicole to relate clearly to the
piano.6 Nicole begins with a descending melodic phrase at :19
into the excerpt; she is sensitive to tempo and phrasing and plays
in the tempo of the ongoing music. Her melodic phrases end on
notes in the harmony as when she stops on a “G” note while Carol
is playing a Gsus4 chord at approximately :33.
By beginning her playing on the first beat of the incipient song
form, Nicole demonstrates her ability to discern the musically
meaningful beat as well as to adapt her playing to suit the form.
Her opening descending phrase contains and continues through
a musical rest. This ability to sustain a melodic idea through a rest
shows her melodic sensitivity, which, along with her entrance on
“pick-up” beats, shows that she has come to music therapy al­
ready being able to function on Level 3 (Aesthetic).
Audio Excerpt #2 (SIDE A): Session 2 (12/13/90)
In this session, the melody for “Here We Are in Music” has
evolved into a more assertive declaration that matches Nicole’s
exuberance in music. The drum and cymbal are being played by
co-therapist, Clive Robbins, to enlarge the experience for Nicole.
At :14, Carol takes Nicole’s left hand and guides her in playing
the melody in the piano’s upper-middle register while Nicole
plays the melodic rhythm with her right hand in the treble.7 At
:38, Carol takes Nicole’s right hand and repeats this “hand-over­
6Unless otherwise noted, Nicole is playing on the treble end of the piano along
with Carol Robbins in all of the following excerpts.
7Nordoff-Robbins Music Therapy can, at times, include the teaching of melodies
through “hand-over-hand”
interventions in order to provide the child with the
knowledge and experience that, through an act of will, she or he can recall and
reproduce a melody.
CognitiveandAffectiveProcesses
in MusicTherapy 35
hand” intervention in a higher register, while Nicole keeps play­
ing the melodic rhythm in her left hand, and at :59 it is repeated
one more time in a still higher register. Nicole briefly starts to
improvise at 1:20, and Carol employs the “hand-over-hand” tech­
nique one last time at 1:30 in the middle register while Clive sings
to Nicole. From 1:44 to the end of the excerpt, Nicole plays
approximations of the melody in the higher register, repeatedly
finding the primary note of ‘G’ matching Clive’s whistling. She
also plays other, complementary melodic lines, particularly
eighth-notes, from 2:05 onward. Nicole is clearly listening and
waiting for the melody to finish before adding her own counter­
melody. She again demonstrates an uncanny ability to find musi­
cally correct notes on which to begin, pause, and end her phrases.
In the teaching of a melody we can clearly see a Level 1 clinical
intervention oriented to a Level 1 process.
Nicole obviously enjoys learning a melody. Her approxima­
tions of the melody are examples of simpler Level 1 (Concrete)
abilities that should be distinguished from the ability to create
variations of a melody, which belong on Level 3 (Aesthetic).
Audio Excerpt #3 (SIDE A): Session 2 (12/13/90)
In this excerpt, in addition to Nicole and Carol Robbins at the
piano, Clive Robbins is playing two handbells.
Nicole begins by reaching across Carol and playing freely in
the lower-middle register of the piano, in a rapid tempo (eighth
notes) with impressive precision. She thenmoves to the treble end.
From :12 to :19, she adjusts her playing to twice as slow but in the
same tempo, and then when Carol’s phrase ends at :19. Nicole
immediately shifts to the eighth notes with Carol. This same
change occurs at :31when Nicole plays quarter and half notes and
then returns to the eighth notes at :39, again precisely at the
turnaround in the incipient song form. She responds to Carol’s
improvised melody, which was taken from a fragment of Nicole’s
playing.
In this excerpt Nicole demonstrates her ability to rapidly inter­
nalize the musical form, which involves alternating phrases. She
is aware of, and can shift between, the musical foreground and
background, as her phrases (in the treble end) become the back­
ground when Carol plays eighth notes, thus indicating her capac-
36
Aigen
ity for textual abstraction as Serafine (1988) defines it (see Table
1). All of these elements suggest skills being consolidated on Level
3 (Aesthetic) as Nicole demonstrates an ability to adjust her play­
ing to function in a complementary way.
Audio Excerpt #4 (SIDE A): Session 8 (2/28/91)
Nicole joins Carol at the piano in what has become her song,
“Here We Are in Music.” While improvising with this song,
Nicole spontaneously segues into the melody of “Little Drummer
Boy” at approximately :20. She plays in the key of G Major, and
Carol modulates from C Major to G. Nicole patiently waits for
Carol to finish the accompaniment pattern before starting the
melody again. Clive Robbins plays the melodic rhythm on a drum
to support Nicole, changing at 1:07 to off-beats to allow Nicole
more autonomy.
Nicole’s accurate rendition of a melody, which includes appro­
priate waiting through musical rests, indicates a complex Level 1
(Concrete) skill. In the last few seconds of the excerpt, when she
begins a phrase on the incorrect note, she is aware of this and
adjusts her playing to finish the phrase on the correct note. This
flexibility suggests that she maintains an internal representation
of the melody, an important piece of evidence that her learning is
not by rote but, instead, involves the capability for abstract
thought.
Audio Excerpt #5 (SIDE A): Session 25
(11/21/91)
As the excerpt begins, Nicole is playing alone with “D” and “E”
notes in the bass and a “D-C#-D” motif in the middle register.
Then she moves her left hand to play an “A” note to form the
interval of a fourth. Carol picks up Nicole’s motif in the bass at :16
and then, a few seconds later, sings along. Carol gently grounds
Nicole’s playing to the tonal center “D” as Nicole explores the
relationship between the leading tone and the tonic. She discovers
the tritone interval forming the basis of dominant seventh chord
to tonic chord. At :59, Carol sings a three-note phrase “A-G-F,”
and Nicole pushes Carol’s hands away from the piano. Nicole
immediately responds to Carol’s phrase with her own three-note
phrase “B-A-A” on the piano. Nicole then listens meditatively
from 1:03 to 1:16. Clive plays in the treble briefly at 1:26. Nicole
Cognitive
and Affective Processes in Music Therapy
37
repeats her cadence at 1:37 with assertion, leading into it with
three single “A” notes. This transitions into a “Goodbye” song as
the excerpt ends.
As Nicole discovers the forces in tonal and harmonic motion by
examining the relationship between dominant and tonic-and the
relationship within the intervals (tritone, perfect fourth) them­
selves--she presents a fairly pure example of musical interaction
on Level 2 (Dynamic Musical Intelligence) and displays her ca­
pacity for tonal synthesis as described by Serafine (1988). Nicole
is exploring the forces present in tonal and harmonic motion and
is using this discovery in making a type of proto-music, that is, a
sound exploration which is not yet music but contains aspects of
that which we recognize as music.
Audio Excerpt #6 (SIDE A): Session 31 (2/13/92)
Nicole, standing at the piano, sways in time while playing
sophisticated melodies that incorporate diatonic and chromatic
aspects. Carol’s accompaniment is even and soft, in order to allow
Nicole’s melodies to come out more fully. The melodies begin to
show Nicole’s evolving musical sophistication in her creative use
of intervallic leaps and changes in melodic direction, all occurring
within a well-patterned framework. Carol takes Nicole’s explora­
tion of minor seconds and introduces the idea of short trills
(embellishments) in order to make them more musical. Nicole’s
melodies are framed by Carol’s accompaniment, which provides
a stable tonic to dominant movement in the bass. The shift of
harmonies opens up the music, and Nicole, to new possibilities,
Nicole’s playing shows her deepening explorations on Level 3
as she is clearly working on melodic statements that go beyond
the scalar runs typical of her early sessions. Her efforts in this area
are more fully developed in the following excerpt.
Audio Excerpt #7 (SIDE A): Session 39 (5/6/92)
The musical context created by Carol in this session frames and
enhances Nicole’s expression. Nicole’s playing takes on a clear
melodic shape with the use of repeats, extensions by adding notes,
and playing in different places (motivic abstraction), all of which
exhibit complex Level 3 (Aesthetic) skills. Her improvised melo­
dies suggest an incipient understanding of a classical cadenza and
38
Aigen
indicate a beautiful aesthetic sensitivity, especially in the phrase
beginning on a trill at :29 that concludes the excerpt. One can only
speculate as to what degree this is self-expressive, although even
in its fragmentary nature, Nicole’s music appears to reach a level
of sublime beauty and tenderness.
Audio Excerpt #8 (SIDE A): Session 44 (9/24/92)
This excerpt includes three portions from one continuous im­
provisation, separated by about 1 minute.
a) After a brief descending, assertive phrase, Nicole
begins precisely played, rapid chromatic phrases. At
:20 she changes to assertive, well defined three-note
phrases and returns to the chromatic playing at :30.
She finds intervals of a dominant seventh, octave,
and a fifth at :40, later seeming to establish a tonal
center around “A” at 1:00.
b) Nicole continues in chromatic playing with a lighter
touch and resting on the interval of a fourth-her
preferred notes of “A” and “D”-before ending tem­
porarily on a double “A“ octave.
c) Throughout this excerpt, Carol sings strongly, gives
Nicole the tonal center of “A” and a stable meter, and
picks out a fragment of her melodic rhythm to help
her relate to the music and organize her playing.
Nicole’s playing is alive and explorative and wildly
chromatic.
At the beginning, Nicole alternates chromatic play­
ing with melodies on the white keys, Carol plays an
ostinato and sings. From :13-:19 Carol plays a series
of ascending chromatic chords. At :23 Nicole finds a
double octave on “A”. She plays again chromatically
with a lighter touch from :23-40 with Carol adding
minor second trills. Nicole changes to white key
melodies and again resolves them to “A” at :54. She
reintroduces the chromatic melodies at :57, changes
again to white keys at 1:15 and ends this series on the
interval of a sixth which she plays ascending one
Cognitive
and Affective Processes in Music Therapy
39
step-from “C-A” to “D-B”­ at 1:35. She returns to the
chromatic playing before finding a double octave on
“A” at 1:47 and ending the excerpt on a single “A”
octave in the bass.
There is a sense of tension and release in Nicole’s
alternation between chromatic playing and melodic
playing with a tonal center. Her interest in minor
seconds has progressed from (a) exploration of the
dissonant quality of the interval, to (b) under­
standing its role in a dominant to tonic movement, to
(c) its use as a trill for a diatonic melody, to (d) the
basis of atonal, chromatic improvising similar to
modern polytonal music or that of free jazz.
Throughout this last excerpt, Nicole’s skills at all levels of the
model can be heard. Her ability to create melodies and to maintain
a sense of rhythm and pulse are elements of Serafine’s (1988)
idiomatic construction characteristic of Level 1 (Concrete). By estab­
lishing a tonal center and maintaining it through time, combining
discrete notes into intervals and changing her played notes but
maintaining the interval, ending her melodies on notes in the tonal
center, and showing a cognizance of the difference between chro­
matic and diatonic music, Nicole demonstrates Serafine’s process
of tonal synthesis, closure,and hierarchic levelsthat occur on Level 2
(Dynamic). Serafine’s cognitive processes of patterning, relative
repetition, and ornamentation-exhibited when Nicole repeats the
pattern of diatonic playing in a stable tonality with chromatic
playing, repeats an interval raised up one step, and repeats a
melodic contour but moving higher in the keyboard’s register
with each repetition, respectively-are all elements that enhance
the Aesthetic value of music, placing them on Level 3. Nicole’s
ability to be fully committed to her music, to create music that
reflects her vitality and life spirit, and that appears to convey the
sense of her inner life, all show her relationship to music on Level
4 (Affective).
40
Aigen
Joshua’s Music
In some ways, Joshua and Nicole are very similar, although the
circumstances of their respective lives could not be more different.
Also autistic, visually­ and intellectually-impaired with little in­
tentional use of speech, Joshua is nonetheless a creative, strong­
willed, sometimes stubborn, child who manages to convey his
inner intelligence and awareness primarily through music. Living
in dangerous, inner-city neighborhoods for much of his life, this
8-year-old boy has none of the middle class comforts afforded to
Nicole. In spite of substantial obstacles, Joshua’s mother-who is
raising him alone-has shown great resourcefulness in estab­
lishing a life for him. Music is Joshua’s primary connection to the
outer world and to other people. At the time this research was
undertaken, Joshua had completed two years of individual music
therapy. His primary therapist was Alan Turry, and his co-thera­
pists were, first, Walter Stafford (sessions l-24) and then Clive
Robbins (sessions 25-44).
Audio Excerpt #9 (SIDE A): Session 17 (3/21/92)
With Alan playing the piano, Joshua is attempting to play the
melody of “Jingle Bells” on the resonator bells with Walter’s
assistance. At :12, he moves to the piano bench and plays a
descending cluster of notes while Walter continues to play the
bells. Joshua then accepts a “hand-over-hand” intervention to
play the melody of “Jingle Bells” at the piano from :20 to :30, at
which point he segues into an improvisation. While playing in the
key of C Major at :40, he anticipates the harmonic movement and
plays a dominant seventh (adding a “B flat” to the “C” chord) to
move the progression to the subdominant chord, “F.” At :48, he
subsequently hears the “F#” in the “D” chord-which
functions
as a dominant of the dominant-and adjusts his playing to include
this note that is not in the key of “C.” He responds to the accom­
paniment rhythm even as he introduces his own melodic idea, a
song not heard before this: “Swanee River” (Old Folks at Home)
at :50. Even as he enters into a new song, Joshua adapts his
phrasing to match the therapist’s
There is a complex Level 1 (Concrete) skill evident in Joshua’s
playing of the melody, and complex Level 2 (Dynamic) skill in his
CognitiveandAffectiveProcesses
in Music Therapy 41
ability to anticipate harmonies and adjust his playing accordingly.
When emphasizing the first beat of the song by leading into it with
eighth-note runs, Joshua shows his cognizance of the importance
of this beat as the beginning of the melody and his skill in having
his fill musically climax here. These appear as relatively sophisti­
cated Level 1 (Concrete) and Level 3 (Aesthetic) skills.
Audio Excerpt #10 (SIDE A): Session 45 (10/2/93)
In this excerpt Joshua is able to display flexibility within the
song as phrases are extended and varieties in harmony are intro­
duced. He plays the melody with both hands and shifts registers
with ease, improvising from one to the other,. showing his cogni­
tive abilities for relative repetition (see Table 1). At the end of the
excerpt, Alan introduces the idea of accompanying the melody
with a bass pattern in the left hand. Alan is firm, and Joshua enjoys
this new musical element.
As the music begins, Joshua is playing the “Swanee River”
melody rubato style in the treble end of the piano accompanied
by Alan. Alan makes a brief arpeggio on a diminished chord from
:03 to :07, and Joshua waits for this to end before continuing the
melody. Joshua plays a trill embellishing the melody at :19 and
then continues the melody one octave higher at :24. At :48, he
continues with the melody in his right hand and allows it to pass
seamlessly to his left hand at :53. When the melody begins again
at :58, Joshua again shifts to an octave higher in the middle of this
phrase at 1:04. At 1:07, Joshua mistakenly plays an “A” note and
then plays his way up to the correct note of C rather than frantic­
ally searching for it. In other words, he corrects himself with
musical intelligence. Alan embellishes this with another dimin­
ished arpeggio moving into the treble end. Joshua again waits for
this arpeggio to end-which
seems to indicate that he under­
stands its musical function as an extension of the dominant
chord-and resumes the melody at 1:12. He concludes at 1:24,
again playing a musically appropriate trill on the last note of the
melody. Alan then implements a “hand-over-hand” intervention
to teach Joshua the bridge melody, and Joshua resumes playing
alone at 1:40. He plays the melody with his left hand in the bass.
At 1:59,Joshua plays a “C” note in the treble, simultaneously with
a “D” in the bass. He immediately corrects himself to play a “C”
42
Aigen
octave and then moves both hands in unison to play a descending
octave.
Alan continues the accompaniment in the treble and bass in a
more staccato style with Joshua now playing the melody in the
middle octave. Joshua plays variations of the melody with a
descending phrase at 2:26.
Level 3 (Aesthetic) skills are clearly evident in Joshua’s orna­
mentation of phrases. He also uses Level 1 (Concrete) skills to
engage with the music and with Alan on a deeper level through
the flexible use of melody and tempo. His ability to play the
melody in different registers and to split it between two hands
shows that Joshua has an internal representation of it, that it is not
a mechanical skill learned by rote. Both his ability to improvise on
the melody and his ability to stay with the shifting, undulating
tempi demonstrate complex Level 3 (Aesthetic) skills.
Audio Excerpt #11 (SIDE A): Session 47 (10/16/93)
Joshua had previously hinted at his familiarity with gospel
music by his style of singing, and so this idiom was introduced.
Here, he uses his voice confidently, improvising melodies and
recognizing the harmonic sequence. His melodies give clear indi­
cations of the harmonic direction. He understands and identifies
with the idiom, singing in a manner consistent with the style.
This excerpt includes two portions from one continuous im­
provisation, separated by 2 minutes.
a) For the first :20, Joshua improvises vocally in the key
of the ongoing music and follows the changes in
harmony. He recognizes the function of the dimin­
ished chord at :20, laughs and waits briefly, and
allows the build-up of suspense to move him to new
territory, singing through the rests on his own. At :55,
Joshua sings in a contextually appropriate falsetto
voice with perfect vibrato.
b) At :05, Joshua plays a brief cluster on the piano in
answer to Alan’s blues phrase and again laughs and
plays over the diminished chord. At :22,he sings sing
a clear “bye” on the tonic. From :30 to :45, Joshua’s
light, aspirated tones represent inner voices in the
Cognitive
and Affective Processes in Music Therapy
43
harmony which lead to subsequent chords. He sings
a tonal vocal trill between the notes of “A” and “GW
at :47and then a clear melody on “D-C#-A” at :55, and
at 1:05, sings clear “D-C#” notes. At 1:25, Joshua
concludes by singing “bye” with clarity and support,
sliding down from “C,” and eventually ending on the
tonic “A” slurring the notes in a way appropriate to
the gospel blues style.
In Joshua’s ability to hear the tension in a diminished chord--or
hear it as an extension of the dominant-and
enjoy this tension,
he shows Level 3 (Aesthetic) awareness. The ability to anticipate
harmonic movement is a relative complex skill on this level, as is
the inventiveness and spontaneity of his melodic, vocal improvis­
ing. The pure joy that Joshua shows suggests that he is capable of
actively engaging in music on Level 4 (Affective).
Conclusion
Although the levels in this model refer to processes within the
client, they can also provide a system for understanding therapist
interventions. Hence, they can be understood as referring to a
hierarchy of client abilities as well as to the scope of treatment
goals. Carol Robbins’ ability to support the music’s continuity,
structure, aesthetic, and emotional essence,in a manner consistent
with its significance for Nicole indicates her clinical interventions
on the four levels respectively.
The levels represent a hierarchy in the sense that an expression
on one of the higher levels presupposes the existence of skills on
the more primary levels. For example, creating a melody with an
aesthetic character (Level 3) requires the existence of skills on
Levels 1 (Concrete Skills) and Level 2 (Dynamic Musical Intelli­
gence). On the other hand, as Table 4 indicates, any given expres­
sion on Level 1 may or may not be more complex than an
expression on a higher Level. So while Level 4 (Affective) expres­
sions, as a class, presuppose the existence of skills on the other
three levels, it is not the case that every Level 4 expression is more
complex than expressions on lower levels.
44
Aigen
The model is hierarchical in a general sense, but not in terms of
individual acts of expression. As one moves up through the levels,
the musical manifestations of the inner processes become increas­
ingly individualized and creative, and ascertaining their status
becomes increasingly subject to the sensitivity of the person doing
the rating. Yet structuring this model in terms of a competence
hierarchy in no way implies a value hierarchy: Goals are pursued
at all levels simultaneously, and the value of more primary proc­
essesis not seen merely in terms of their usefulness in facilitating
expressions on higher levels. Because the music therapy process
involves constant movement among levels, the hierarchy does not
represent a developmental sequence, either for the course of
therapy in general or for a given individual.
Music therapy for developmentally-disabled individuals in­
volves meeting their most pressing life needs and providing
situations in which they can experience themselves as more fully
human. This incorporates-and
serves as the justification
for-work on all of these levels aspart of music therapy. Although
the work on the lower levels can resemble educational practice,
the context of therapy imbues the skill training with clinical
possibilities not inherent in a typical educational milieu. These
possibilities include using the developing of skills to (a) create or
strengthen the therapeutic relationship; (b) serve as a spontaneous
entry point to deeper levels of emotional expression; and, (c)
address typically psychotherapeutic goals, such as enhancing
self-esteem.
Thus, while music psychotherapy can occur more overtly on
the upper levels as the affect and creativity of the individual
become increasingly more important, work on all of the levels has
a place in a music psychotherapeutic treatment model. This is
determined more by the rationale behind a given intervention,
and the quality with which it is enacted, than by a context-free
description of the intervention.
In this view, for example, asking a client, “How did that feel?”
is not inherently more psychotherapeutic than is the teaching of
a melody because the judgment as to what constitutes a psycho­
therapeutic intervention is context-dependent, with the relevant
context consisting of things such as the present state and needs of
the client, and the sensibility and sensitivity of the therapist.
Cognitive
and Affective Processes in Music Therapy
45
Relationship goals, which are often of primary importance for
the developmentally delayed, can be addressed at all of the levels.
For example, it is possible that a resistive child who begins to
allow the teaching of a melody through a “hand-over-hand”
intervention is showing significant growth in interpersonal relat­
ing by tolerating or even enjoying this type of learning and
physical contact. In this way, the intervention addresses a typi­
cally psychotherapeutic goal, although the means for achieving
this goal appears purely educative.
References
Aigen, K. (in press). Here we are in music: One year with an adolescent, creative music
therapy group. St. Louis, MO: MMB Music.
Brig s. C. (1991). A model for understanding
musical development.
Music
Therapy, 10(l), l-21.
Alvin, J. (1965). Music for the handicapped child. London: Oxford University Press.
Boxill, E. (1985). Music therapy for the developmentally disabled. Rockville, MD:
Aspen.
Ely, M., Anzul, M., Friedman, T., Gamer D., & Steinmetz, A. M. (1991). Doing
qualitative research: Circles within circles. London: The Falmer Press.
Erlandson, D., Harris, E., Skipper, B., & Allen, S. (1993). Doing naturalistic inquiry:
A guide to methods. Newbury Park, CA: Sage.
Guba, E., & Lincoln, Y. (1981). Effective evaluation: Improving the usefulness of
evaluation results through responsive and naturalistic approaches. San Francisco:
Jossey-Bass.
Lincoln, Y., & Guba, E. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.
Meyer, L.B. (1956). Emotion and meaning in music. Chicago: University of Chicago
Nordoff, P., & Robbins, C. (1977). Creative music therapy. New York: John Day.
Nordoff, P., & Robbins, C. (in press). Creative music therapy, (2nd ed.). St. Louis,
MO: MMB Music.
Orff, G. (1974). The Orff music therapy. London: Schott & Co.
Robbins, C., & Robbins, C. (1991). Self-communications
in creative music ther­
apy. In K. E. Bruscia (Ed.), Case studies in music therapy (pp. 55-71).
Phoenixville, PA: Barcelona Publishers.
Schon, D. (1983). The reflexive practitioner. Basic Books. Serafine, M. L. (1988).
Music as cognition: The development ofthought in sound. New York: Columbia
University Press.
Stake, R. E. (1978). The case study method in social inquiry. Educational Re­
searcher, 7, 5-8.
46
Aigen
Research and a clini-